Citation Nr: 21031234 Decision Date: 05/21/21 Archive Date: 05/21/21 DOCKET NO. 17-36 306 DATE: May 21, 2021 REMANDED Entitlement to service connection for sleep disorder to include obstructive sleep apnea and as secondary to service-connected posttraumatic stress disorder is remanded. REASONS FOR REMAND The Veteran has active service from March 1984 to February 1987 and from August 1989 to August 1994. This case is before the Board of Veterans' Appeals (Board) from an April 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran appeared before the undersigned Veterans' Law Judge at a February 2021 hearing. Veteran contends he did not have any sleep problems prior to service in Desert Storm. He asserts his service-connected PTSD has caused his sleep apnea. (8/20/2014 NOD). During his hearing the Veteran described the nature of his service, that included night operations that did not allow him to sleep on a regular schedule, and asserted that this led to his sleep disturbance problems. The Veteran also confirmed his bunkmates complained they could not sleep because the Veteran snored loudly. The Veteran also confirmed that during service he was not aware it was a medical issue. Of record is a statement from a fellow service member noting the Veteran's in-service snoring, supporting the Veteran's hearing testimony (03/04/2021 Buddy/Lay Statement; Hearing Transcript on VBMS). The Veteran's former spouse also provided a letter confirming from 1991 to 2005 his nightly snoring that could be heard outside the bedroom, was accompanied by snorting that sounded like his breathing was being cut off (12/12/2017 Buddy / Lay Statement). The Veteran has current diagnoses of insomnia and sleep apnea (10/17/2013 Disability Benefits Questionnaire (DBQ) - Veteran Provided). Of record is a letter from a private physician confirming the Veteran has a sleep disorder. The treating physician also opined that the Veteran's sleep disorder is a result of his service-connected PTSD, without additional explanation or rationale (8/20/2014 Medical Treatment Record - Non-Government Facility). The Veteran was afforded a February 2018 VA examination for sleep apnea. The examiner opined the Veteran's sleep apnea was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event or illness (02/02/2018 C&P Exam). The examiner provided an extensive rationale, but did not address the Veteran's insomnia as a separate sleep disorder, did not provide an opinion as to whether the Veteran's sleep apnea is secondary to his service connected PTSD, and did not address whether the in-service snoring and snorting as described by the Veteran's spouse and fellow service member were symptoms suggestive of inservice onset of sleep apnea or any other sleep disorder. In light of the omissions described, the Board finds the medical evidence of record to be inadequate and remand for a new exam is required. The matters are REMANDED for the following action: Schedule the Veteran for an examination by an appropriately qualified clinician to determine the nature and etiology of any existing sleep disorder, to include sleep apnea and insomnia. The examiner should review the entire claims file and this remand in conjunction with the examination. The examiner is requested to render an opinion as to whether it is at least as likely as not (i.e., a likelihood of 50 percent or more) that any currently diagnosed sleep disorder/disability is a result of service or any incident occurring during service. The examiner should address the lay statements by a fellow service member and the Veteran's wife describing the Veteran's snoring, snorting in his sleep, sounds like his breathing was being cut off. The examiner should indicate if the described symptoms are suggestive of in-service onset of a sleep disorder/disability. The examiner should also provide an opinion as to whether the Veteran's obstructive sleep apnea is at least as likely as not (50 percent probability) proximately due to service-connected posttraumatic stress disorder. If not, then the examiner should address whether it is as likely as not (50 percent probability) that the Veteran's service-connected posttraumatic stress disorder has aggravated his obstructive sleep apnea beyond its natural progression. If aggravation is found, the examiner should identify baseline level of disability prior to such aggravation. The examiner is reminded to consider the Veteran's lay reports, and a reason must be provided if the Veteran's lay reports are rejected. Lay statements cannot be rejected solely due to a lack of medical documentation. If there is a medical reason to accept or not accept the Veteran's contentions of in-service sleep difficulty, the examiner should provide them. If the absence of medical documentation is relevant, the relevance must be explained because the absence of evidence is not positive evidence of the existence or non-existence of an event. If the examiner is able to gather additional understanding or information regarding the circumstances surrounding any inservice injury or event, the examiner should include that information in his remarks. The examiner should reconcile any conflicting medical evidence of record to the extent possible to include the February 2018 VA examination and the August 2014 letter from a private physician that the Veteran's sleep disorder is a result of and secondary to his PTSD. (Continued on the next page) The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and explain why this is so, (e.g., whether an opinion is beyond what any medical practitioner might be able to provide, based on the evidence of record and current medical knowledge). Eric S. Leboff Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P. A. Myers The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.